OBJECTIVES: Projecting epidemiologic trends in antibiotic resistance is important for developing strategies to tackle the global antimicrobial resistance crisis. Acinetobacter baumannii is a leading cause of hospital-associated infections, particularly in China. This analysis aimed to estimate the current burden of multidrug-resistant A. baumannii (MDRAB) in China and forecast epidemiologic trends in the emergence of multidrug-resistant, hospital-associated urinary tract infection (UTI).

METHODS: MDRAB UTI rates were estimated using published surveillance data of hospital-associated infections in China. Future resistance rates were simulated based on historic trends accounting for multiple factors, including antibiotic exposure and stewardship. Two broad growth scenarios were projected: log growth (assuming improved infection-control practices) and sigmoidal growth.

RESULTS: Among UTIs with a reported causative pathogen in China between 2014 and 2015, 60% were caused by gram-negative bacteria, of which 3.9% were A. baumannii (Chen et al. J Hosp Infect. 2017;95:105–111). MDRAB rates among A. baumannii UTIs increased from 15% in 2007 to 57% in 2014 (Gao et al. Chin Med J. 2017;130;659–664). Based on the two growth scenarios, MDRAB rates were projected to moderately increase from 2015, with estimated rates of 57–58% in 2015, 62–68% in 2025, 64–71% in 2030, and 67–76% in 2040.

CONCLUSIONS: More than half of A. baumannii UTIs from 2013 are estimated to be multidrug resistant, with resistance projected to increase through 2040. A gradual plateau in the emergence of MDRAB from 2015 assumes low probability of indefinite resistance growth, containment within hospital settings, and the potential impact of improved stewardship and infection control. The projected growth of MDRAB highlights the urgent need to implement approaches to minimize emergence of resistance and its impact on patients, including preserving the effectiveness of existing antibiotics and the development of new options.